NPI | 1942842307 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C08619) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MD 98886547) |
Enumeration Date | 2019-10-16 |
Last Update Date | 2023-01-19 |